Betty stopped and looked at me. “You think I’m crazy?”
“No, I told you before, you don’t have the knack for it.”
She smiled. “I’ve never told that story to anyone. In fact I’d forgotten it, forgotten it for years until this week.”
“I feel good you’re willing to trust me with it. It sounds important. Say some more about being ‘next.’”
“It’s like my father was no longer there to protect me. In a way he stood between me and the grave. Without him there, I was next in line.” Betty hunched up her shoulders and shuddered. “Can you believe I still feel spooky when I think about this?”
“Your mother? Where was she in all this?”
“Like I’ve told you before—way, way in the background. She cooked and she fed me—she was real good at that—but she was weak—I was the one protecting her. Can you believe a Texan who can’t drive? I started driving at twelve when my father got sick, because she was afraid to learn.”
“So there was no one shielding you?”
“That’s when I started having nightmares. That dream about the candle—I must have had it twenty times.”
“That dream makes me think of what you said before about your fear of losing weight, about having to stay heavy to avoid dying of cancer like your father. If the candle flame stays fat, you live.”
“Maybe, but sounds farfetched.”
Another good example, I thought, of the pointlessness of the therapist rushing in with an interpretation, even a good one like this. Patients, like everyone else, profit most from a truth they, themselves, discover.
Betty continued, “And somewhere in that year I got the idea I was going to die before I was thirty. You know, I think I still believe that.”
These discussions undermined her denial of death. Betty began to feel unsafe. She was always on guard against injury—when driving, bicycling, crossing the street. She became preoccupied with the capriciousness of death. “It could come at any instant,” she said, “when I least expect it.” For years her father had saved money and planned a family trip to Europe only to develop a brain tumor shortly before the departure date. She, I, anyone, can be struck down at any time. How does anyone, how do I, cope with that thought?
Now committed to being entirely “present” with Betty, I tried not to flinch from any of her questions. I told her of my own difficulties in coming to terms with death; that, though the fact of death cannot be altered, one’s attitude toward it can be vastly influenced. From both my personal and my professional experience, I had come to believe that the fear of death is always greatest in those who feel that they have not lived their life fully. A good working formula is: the more unlived life, or unrealized potential, the greater one’s death anxiety.
My hunch was, I told Betty, that when she entered more fully into life, she would lose her terror of death—some, not all of it. (We are all stuck with some anxiousness about death. It’s the price of admission to self-awareness.)
At other times Betty expressed anger at my forcing her to think about morbid topics. “Why think about death? We can’t do anything about it!” I tried to help her understand that, though the fact of death destroys us, the idea of death can save us. In other words, our awareness of death can throw a different perspective on life and incite us to rearrange our priorities. Carlos had learned that lesson—it was what he meant on his deathbed when he talked about his life having been saved.
It seemed to me that an important lesson Betty could learn from an awareness of death was that life had to be lived now; it could not be indefinitely postponed. It was not difficult to lay out before her the ways she avoided life: her reluctance to engage others (because she dreaded separation); her overeating and obesity, which had resulted in her being left out of so much life; her avoidance of the present moment by slipping quickly into the past or the future. It was also not difficult to argue that it was within her power to change these patterns—in fact she had already begun: consider how she was engaging me that very day!
I encouraged her to plunge into her grief; I wanted her to explore and express every facet of it. Again and again, I asked the same question: “Who, what, are you grieving for?”
Betty responded, “I think I’m grieving for love. My daddy was the only man who ever held me in his arms. He was the only man, the only person, who told me he loved me. I’m not sure that will come my way again.”
I knew we were entering an area where once I would never have dared to go. It was hard to remember that less than a year before it had been difficult for me even to look at Betty. Today I felt positively tender toward her. I stretched to find a way to respond, but still it was less than I wanted to give.
“Betty, being loved is not sheer chance or fate. You can influence it—more than you think. You are much more available for love now than you were a few months ago. I can see, I can feel the difference. You look better, you relate better, you are so much more approachable and available now.”
Betty was more open with her positive feelings toward me and shared long daydreams in which she became a physician or a psychologist and she and I worked together side by side on a research project. Her wish that I could have been her father led us into one final aspect of her grief that had always caused her much torment. Alongside her love for her father, she also had negative feelings: she felt ashamed of him, of his appearance (he was extremely obese), of his lack of ambition and education, of his ignorance of social amenities. As she said this, Betty broke down and sobbed. It was so hard to talk about this, she said, because she was so ashamed of being ashamed of her own father.
As I searched for a reply, I remembered something my first analyst, Olive Smith, said to me over thirty years before. (I remember it well, I think, because it was the only remotely personal—and the most helpful—thing she said in my six hundred hours with her.) I had been badly shaken by having expressed some monstrous feelings about my mother, and Olive Smith leaned over the couch and said gently, “That just seems to be the way we’re built.”
I cherished those words; and now, thirty years later, I passed along the gift and said them to Betty. The decades had eroded none of their restorative powers: she exhaled deeply, calmed herself, and sat back in her chair. I added that I knew personally how difficult it is for highly educated adults to relate to uneducated blue-collar parents.
Betty’s year-and-a-half assignment in California was now drawing to a close. She did not want to stop therapy and asked her company to extend her time in California. When that failed, she considered searching for a job in California but ultimately decided to return to New York.
What a time to stop—in the midst of work on important issues and with Betty still camped outside the one-hundred-fifty-pound roadblock! At first I thought that the timing could not have been worse. Yet, in a more reflective moment, I realized that Betty may have plunged so deeply into therapy because of, not despite, our limited time frame. There is a long tradition in psychotherapy going back to Carl Rogers and, before him, to Otto Rank, which understood that a preset termination date often increases the efficiency of therapy. Had Betty not known that her time in therapy was limited, she might, for example, have taken far longer to achieve the inner resolve she needed to begin her weight loss.
Besides, it was by no means clear that we could have gone much further. In our last months of therapy, Betty seemed interested more in resolving the issues we had already opened than in uncovering new ones. When I recommended that she continue therapy in New York and offered her the name of a suitable therapist, she was noncommital, stating that she wasn’t sure whether she would continue, that maybe she had done enough.
There were other signs as well that Betty might go no further. Though not bingeing, she was no longer dieting. We agreed to concentrate on maintaining her new weight of one hundred sixty and, to that end, Betty bought a whole new wardrobe.
A dream illuminated this juncture in therapy:I dreamed that the painters were supposed to pa
int the outside trim of my house. They were soon all over the house. There was a man at every window with a spray gun. I got dressed quickly and tried to stop them. They were painting the whole outside of the house. There were wisps of smoke coming up all over the house from between the floorboards. I saw a painter with a stocking over his face spraying inside the house. I told him I just wanted the trim painted. He said he had orders to paint everything, inside and out. “What is the smoke?” I asked. He said it was bacteria and added they had been in the kitchen culturing deadly bacteria. I got scared and kept saying over and over, “I only wanted the trim painted.”
At the onset of therapy, Betty had indeed wanted only the trim painted but had been drawn inexorably into reconstructive work on the deep interior of the house. Moreover, the painter-therapist had sprayed death—her father’s death, her own death—into her house. Now she was saying she had gone far enough; it was time to stop.
As we neared our final session, I felt a mounting relief and exhilaration—as though I had gotten away with something. One of the axioms of psychotherapy is that the important feelings one has for another always get communicated through one channel or another—if not verbally, then nonverbally. For as long as I can remember, I have taught my students that if something big in a relationship is not being talked about (by either patient or therapist), then nothing else of importance will be discussed either.
Yet I had started therapy with intense negative feelings about Betty—feelings I had never discussed with her and that she had never recognized. Nevertheless, without doubt, we had discussed important issues. Without doubt, we had made progress in therapy. Had I disproven the catechism? Are there no “absolutes” in psychotherapy?
Our final three hours were devoted to work on Betty’s distress at our impending separation. What she had feared at the very onset of treatment had come to pass: she had allowed herself to feel deeply about me and was now going to lose me. What was the point of having trusted me at all? It was as she had said at first: “No involvement, no separation.”
I was not dismayed by the re-emergence of these old feelings. First, as termination approaches, patients are bound to regress temporarily. (There is an absolute.) Second, issues are never resolved once and for all in therapy. Instead, therapist and patient inevitably return again and again to adjust and to reinforce the learning—indeed, for this very reaso, psychotherapy has often been dubbed “cyclotherapy.”
I attempted to address Betty’s despair, and her belief that once she left me all our work would come to naught, by reminding her that her growth resided neither in me nor in any outside object, but was a part of her, a part she would take with her. If, for example, she was able to trust and to reveal herself to me more than to anyone previously, then she contained within herself that experience as well as the ability to do it again. To drive my point home, I attempted, in our final session, to use myself as an example.
“It’s the same with me, Betty. I’ll miss our meetings. But I’m changed as a result of knowing you—”
She had been crying, her eyes downcast, but at my words she stopped sobbing and looked toward me, expectantly.
“And, even though we won’t meet again, I’ll still retain that change.”
“What change?”
“Well, as I mentioned to you, I hadn’t had much professional experience with . . . er . . . with the problem of obesity——” I noted Betty’s eyes drop with disappointment and silently berated myself for being so impersonal.
“Well, what I mean is that I hadn’t worked before with heavy patients, and I’ve gotten a new appreciation for the problems of—–” I could see from her expression that she was sinking even deeper into disappointment. “What I mean is that my attitude about obesity has changed a lot. When we started I personally didn’t feel comfortable with obese people——”
In unusually feisty terms, Betty interrupted me. “Ho! ho! ho! ‘Didn’t feel comfortable’—that’s putting it mildly. Do you know that for the first six months you hardly ever looked at me? And in a whole year and a half you’ve never—not once—touched me? Not even for a handshake!”
My heart sank. My God, she’s right! I have never touched her. I simply hadn’t realized it. And I guess I didn’t look at her very often, either. I hadn’t expected her to notice!
I stammered, “You know, psychiatrists don’t ordinarily touch their——”
“Let me interrupt you before you tell any more fibs and your nose gets longer and longer like Pinocchio.” Betty seemed amused at my squirming. “I’ll give you a hint. Remember, I’m in the same group with Carlos and we often chat after the group about you.”
Uh-oh, I knew I was cornered now. I hadn’t anticipated this. Carlos, with his incurable cancer, was so isolated and felt so shunned that I had decided to support him by going out of my way to touch him. I shook his hand before and after each hour and usually put my hand on his shoulder as he left the office. Once, when he learned about the spread of his cancer to his brain, I held him in my arms while he wept.
I didn’t know what to say. I couldn’t point out to Betty that Carlos was a special case, that he needed it. God knows she had needed it, too. I felt myself flushing. I saw I had no choice but to own up.
“Well, you’re pointing out one of my blind spots! It is true—or, rather, was true—that, when we first began to meet, I was put off by your body.”
“I know. I know. It wasn’t too subtle.”
“Tell me, Betty, knowing this—seeing that I didn’t look at you or was uncomfortable with you—why did you stay? Why didn’t you stop seeing me and find someone else? Plenty of other shrinks around.” (Nothing like a question to get off the hot seat!)
“Well, I can think of at least two reasons. First, remember that I’m used to it. It’s not like I expect anything more. Everyone treats me that way. People hate my looks. No one ever touches me. That’s why I was surprised, remember, when my hairdresser massaged my scalp. And, even though you wouldn’t look at me, you at least seemed interested in what I had to say—no, no, that’s not right—you were interested in what I could or might say if I stopped being so jolly. Actually, that was helpful. Also, you didn’t fall asleep. That was an improvement on Dr. Farber.”
“You said there were two reasons.”
“The second reason is that I could understand how you felt. You and I are very much alike—in one way, at least. Remember when you were pushing me to go to Overeaters Anonymous? To meet other obese people—make some friends, get some dates?”
“Yeah, I remember. You said you hated groups.”
“Well, that’s true. I do hate groups. But it wasn’t the whole truth. The real reason is that I can’t stand fat people. They turn my stomach. I don’t want to be seen with them. So how can I get down on you for feeling the same way?”
We were both on the edge of our chairs when the clock said we had to finish. Our exchange had taken my breath away, and I hated to end. I didn’t want to stop seeing Betty. I wanted to keep on talking to her, to keep on knowing her.
We got up to leave, and I offered her my hand, both hands.
“Oh no! Oh no, I want a hug! That’s the only way you can redeem yourself.”
When we embraced, I was surprised to find that I could get my arms all the way around her.
5
“I Never Thought It Would Happen to Me”
I greeted Elva in my waiting room, and together we walked the short distance to my office. Something had happened. She was different today, her gait labored, discouraged, dispirited. For the last few weeks there had been a bounce in her steps, but today she once again resembled the forlorn, plodding woman I had first met eight months ago. I remember her first words then: “I think I need help. Life doesn’t seem worth living. My husband’s been dead for a year now, but things aren’t getting any better. Maybe I’m a slow learner.”
But she hadn’t proved to be a slow learner. In fact, therapy had progressed remarkably well—maybe it had been go
ing too easily. What could have set her back like this?
Sitting down, Elva sighed and said, “I never thought it would happen to me.”
She had been robbed. From her description it seemed an ordinary purse snatching. The thief, no doubt, spotted her in a Monterey seaside restaurant and saw her pay the check in cash for three friends—elderly widows all. He must have followed her into the parking lot and, his footsteps muffled by the roaring of the waves, sprinted up and, without breaking stride, ripped her purse away and leaped into his nearby car.
Elva, despite her swollen legs, hustled back into the restaurant to call for help, but of course it was too late. A few hours later, the police found her empty purse dangling on a roadside bush.
Three hundred dollars meant a lot to her, and for a few days Elva was preoccupied by the money she had lost. That concern gradually evaporated and in its place was left a bitter residue—a residue expressed by the phrase “I never thought it would happen to me.” Along with her purse and her three hundred dollars, an illusion was snatched away from Elva—the illusion of personal specialness. She had always lived in the privileged circle, outside the unpleasantness, the nasty inconveniences visited on ordinary people—those swarming masses of the tabloids and newscasts who are forever being robbed or maimed.
The robbery changed everything. Gone was the coziness, the softness in her life; gone was the safety. Her home had always beckoned her with its cushions, gardens, comforters, and deep carpets. Now she saw locks, doors, burglar alarms, and telephones. She had always walked her dog every morning at six. The morning stillness now seemed menacing. She and her dog stopped from time to time and listened for danger.